Korean J Anesthesiol.  2012 Jan;62(1):35-39. 10.4097/kjae.2012.62.1.35.

Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery

• Yoon HJ
• Cho HJ
• Lee IH
• Jee YS
• Kim SM

• KMID: 2236449
• DOI: http://doi.org/10.4097/kjae.2012.62.1.35

Abstract

BACKGROUND
Hypotension remains a common clinical problem of spinal anesthesia for cesarean delivery and phenylephrine is used as a vasopressor to address this. However, phenylephrine reduces maternal cardiac output (CO) due to reflex bradycardia. Glycopyrrolate is safe for the fetus, and increases heart rate (HR). Using a noninvasive measure of CO, we compared maternal hemodynamic changes between the phenylephrine only group (group P) and the phenylephrine plus glycopyrrolate group (group PG).
METHODS
In this randomized study, 60 women scheduled for elective cesarean delivery were allocated to group P (n = 30) or group PG (n = 30). In both groups, phenylephrine was infused at 50 microg/min. This infusions stopped if systolic blood pressure (SBP) was higher than the baseline value, and phenylephrine 100 microg was injected if SBP was lower than 80% of the baseline value from spinal anesthesia to delivery. In group PG, glycopyrrolate 0.2 mg was injected intravenously after spinal anesthesia. Hemodynamic parameters, such as SBP, heart rate (HR), stroke volume index (SVI), cardiac index (CI) were measured before and until 15 min after spinal anesthesia.
RESULTS
There were no significant differences in SBP and SVI compared to the baseline value in each group and between the two groups. HR and CI reduced significantly from 8 min to 15 min in group P compared to the baseline value as well as group PG for each time-point. However, HR and CI were maintained in group PG.
CONCLUSIONS
The use of glycopyrrolate added to phenylephrine infusion to prevent hypotension by spinal anesthesia for cesarean delivery was effective in maintaining HR and CI.

Keyword

Cesarean section; Glycopyrrolate; Hypotension; Phenylephrine; Spinal anesthesia

MeSH Terms

Anesthesia, Spinal
Blood Pressure
Bradycardia
Cardiac Output
Cesarean Section
Female
Fetus
Glycopyrrolate
Heart Rate
Hemodynamics
Humans
Hypotension
Phenylephrine
Pregnancy
Reflex
Stroke Volume
Glycopyrrolate
Phenylephrine